Substance Abuse Problem Treated
Beds Designated for Substance Abuse Treatment
Fig. 6 Residential and hospital inpatient utilization rates: October 1, 2000
This chapter describes key characteristics of facilities and programs in 2000. Facilities are described in terms of ownership, that is, the type of entity owning or responsible for the operation of the facility: private for-profit, private non-profit, or government (Federal, State, local, or tribal). They are also described in terms of the facility’s primary focus: substance abuse treatment services, mental health services, general health care, both substance abuse and mental health services, and other.
Table 3.1. Overall, 61 percent of facilities reported that treating substance abuse problems was their primary focus of activity. Nine percent of all facilities reported mental health services as their main focus, while three percent focused on general health care. One-quarter of all facilities focused on a balance of substance abuse and mental health services. The VA had the largest proportion (46 percent) of facilities that reported a general health focus, and the smallest proportion (29 percent) with a primary focus of substance abuse treatment.
Tables 3.2a and 3.2b. Outpatient rehabilitation was the most widely available type of care, with non-intensive and intensive rehabilitation offered by 78 percent and 46 percent of all facilities, respectively. Residential rehabilitation was offered by 26 percent of all facilities, while hospital inpatient rehabilitation was offered by 5 percent of facilities. Sixteen percent of all facilities provided partial hospitalization programs. Outpatient detoxification was available at 13 percent of facilities, while residential detoxification and hospital inpatient detoxification were each provided by 8 percent of all facilities.
As a group, Federally owned facilities were most likely to offer all types of outpatient care including non-intensive and intensive rehabilitation, detoxification, and partial hospitalization (94 percent, 58 percent, 42 percent, and 28 percent, respectively). Residential rehabilitation was more likely to be offered by private non-profit facilities (33 percent).
Facilities that focused primarily on substance abuse treatment were least likely to provide hospital inpatient care (both rehabilitation and detoxification) and most likely to provide residential care (both rehabilitation and detoxification). Facilities with general health care as a primary focus, which comprise less than 3 percent of all treatment facilities in the survey, were most likely to provide hospital inpatient care (both rehabilitation and detoxification), and the less common forms of outpatient care (intensive outpatient, outpatient detoxification, and partial hospitalization).
Tables 3.2a and 3.2b. Methadone/LAAM was dispensed by 9 percent of all facilities. Facilities most likely to dispense methadone/LAAM were private for-profit facilities (14 percent) and Federal government facilities (12 percent), particularly the facilities operated by the VA (22 percent). State government-owned facilities were also more likely than average to dispense methadone/LAAM (12 percent).
Facilities with a general health care or substance abuse focus were more likely to dispense methadone/LAAM (19 percent and 11 percent, respectively) than facilities with a focus on both substance abuse and mental health or on mental health only (5 percent each).
Table 3.3. As recently as 1980, the Federal government surveyed facilities treating alcohol and drug abuse separately. By 2000, however, the vast majority of facilities (95 percent) treated both alcohol and drug abuse. The Department of Defense had the highest proportion of facilities that treated alcohol abuse only (36 percent). The proportion of facilities that treated only drug abuse ranged among ownership categories from zero to 6 percent. Regardless of the primary focus of the facility, well over 90 percent of facilities treated both alcohol and drug abuse.
Table 3.4. Cash/self-payment and private insurance were the most widely accepted forms of payment for substance abuse treatment (accepted overall by 90 percent and 71 percent of facilities, respectively). Medicaid was accepted by just over half of all facilities (54 percent). Federal military insurance and Medicare were accepted by roughly one-third of all facilities (34 percent and 37 percent, respectively).
The type of payment accepted varied considerably by ownership. Local and State government-owned facilities, private non-profit facilities, and Indian Health Service facilities were the most likely to accept Medicaid and Medicare payments for substance abuse treatment.
Facilities with a focus on substance abuse treatment were least likely to accept the full range of insurance types; fewer than one quarter accepted Medicare or Federal military insurance, fewer than one half accepted Medicaid, and just under two-thirds accepted private insurance. About two-thirds of these facilities, however, offered a sliding fee scale, roughly the same proportion as facilities with a focus on mental health (also 66 percent) or on substance abuse/mental health combined (72 percent).
Table 3.4. A sliding fee scale for substance abuse treatment was offered by approximately two-thirds (67 percent) of all facilities. The sliding fee scale was most likely to be offered in State and local government-owned facilities (72 percent and 83 percent, respectively) as well as private non-profit (72 percent) facilities. It was least likely to be offered in Federally owned facilities (18 percent). General health care focused facilities were less likely than other facilities to offer a sliding fee scale (38 percent).
Tables 3.5a and 3.5b. Facilities may offer treatment programs designed to address the specific needs of certain groups. These groups include dually diagnosed (persons with a mental illness and co-occurring substance abuse), adolescents, persons with HIV/AIDS, gays and lesbians, older adults, and pregnant or postpartum women. Special programs may also be designed for groups of men or women (other than pregnant or postpartum women), or persons in the criminal justice system. Many facilities offer treatment for persons arrested while driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI).
Overall, half of all facilities provided programs for the dually diagnosed. These services were most likely to be provided by:
VA-owned facilities (72 percent)
Indian Health Service facilities (65 percent)
Facilities with a substance abuse and mental health focus (70 percent)
Facilities with a mental health focus (66 percent)
Facilities least likely to have programs for the dually diagnosed were:
Department of Defense-owned facilities (40 percent)
Tribal government-owned facilities (42 percent)
Facilities with a substance abuse focus (39 percent)
Thirty-seven percent of facilities offered programs for adolescents. These programs were found most often in:
Indian Health Service facilities (73 percent)
Tribal government-owned facilities (65 percent)
Facilities with a substance abuse and mental health focus (50 percent)
Adolescent programs were least likely to be in:
VA-owned facilities (no adolescent programs)
Department of Defense-owned facilities (4 percent)
Facilities with a general health care focus (22 percent)
About one-fifth (22 percent) of facilities offered programs for persons with HIV/AIDS. These programs were most likely to be in:
VA-owned facilities (32 percent)
State government-owned facilities (25 percent)
Indian Health Service facilities (25 percent)
HIV/AIDS programs were least likely to be offered by:
Department of Defense-owned facilities (8 percent)
Tribal government-owned facilities (17 percent)
Facilities with a mental health focus (12 percent)
Overall, special groups for gays and lesbians were available at 15 percent of facilities, which were most likely to be:
Indian Health Service facilities (23 percent)
Private for-profit facilities (19 percent)
Tribal government-owned facilities (17 percent)
Facilities that focused on both substance abuse and mental health (17 percent)
Facilities least likely to offer programs for gays and lesbians were:
Department of Defense-owned facilities (4 percent)
VA-owned facilities (11 percent)
Programs for pregnant or postpartum women were offered by 21 percent of facilities. These programs were most likely to be available at:
Local government-owned facilities (30 percent)
Tribal government-owned facilities (29 percent)
Indian Health Service facilities (28 percent)
These programs for pregnant or postpartum women were least likely to be offered by:
VA-owned facilities (6 percent)
Department of Defense-owned facilities (12 percent)
Facilities with a mental health focus (12 per cent)
Programs for other women’s groups were provided by 38 percent of facilities, most often at:
Local government-owned facilities (48 percent)
Indian Health Service facilities (48 percent)
State government-owned facilities (43 percent)
Facilities with a substance abuse focus (42 percent)
Facilities least likely to offer these programs were:
Department of Defense-owned facilities (19 percent)
Facilities with a mental health focus (20 percent)
Programs for men only were provided by 33 percent of all facilities and most often by:
Private non-profit facilities (35 percent)
Indian Health Service facilities (35 percent)
Local government-owned facilities (34 percent)
Facilities with a substance abuse focus (37 percent)
Least likely to offer programs for men only were:
Department of Defense-owned facilities (16 percent)
Facilities with a mental health focus (16 percent)
Eighteen percent of all facilities provided programs for seniors or older adults. Facilities most likely to have this type of program included:
Tribal government-owned facilities (29 percent)
VA-owned facilities (28 percent)
Indian Health Service facilities (28 percent)
Facilities least likely to offer special programs for seniors or older adults were:
Department of Defense-owned facilities (11 percent)
State government-owned facilities (13 percent)
Facilities with a substance abuse focus (15 percent)
Thirty-eight percent of all facilities offered programs for persons in the criminal justice system. (Facilities treating incarcerated persons only were excluded from this survey; see Chapter 1.) These types of programs were most likely to be provided by:
Indian Health Service facilities (43 percent)
Local government-owned facilities (41 percent)
Facilities with an equal focus on substance abuse and mental health (41 percent)
Facilities with a substance abuse focus (39 percent)
Least likely to provide programs for persons referred from the criminal justice system were:
VA-owned facilities (11 percent)
Department of Defense-owned facilities (12 percent)
Facilities with a general health care focus (18 percent)
Special programs for those arrested for DUI/DWI were offered by 36 percent of all facilities. Those facilities most likely to provide this type of program included:
Private for-profit facilities (49 percent)
Facilities with a substance abuse and mental health focus (46 percent)
Least likely to offer DUI/DWI programs were:
VA-owned facilities (22 percent)
Facilities with a general health care focus (23 percent)
Tables 3.6a and 3.6b, Tables 3.7a and 3.7b. Facilities were asked about the types of services they offered. Services were grouped into five broad categories:
Assessment services
Substance abuse therapy and counseling
Testing
Transitional services
Other services
A majority of facilities offered one or more services in each category. Only 10 facilities reported offering none of the identified services. Overall, substance abuse therapy and counseling was offered by the largest proportion of facilities (99-100 percent across ownership categories; 96-100 percent across primary focus categories). The availability of most specific services varied somewhat by ownership and primary focus. Differences were most apparent in testing and transitional services.
Table 3.6. In general, fewer private for-profit facilities offered a range of testing and transitional services as compared with the range of these services offered by Federal and State government-owned facilities.
Table 3.7. Facilities with a focus on general health care generally provided more testing and transitional services than facilities with other types of focus. Overall, a lower proportion of facilities focused on mental health offered other types of services such as HIV/AIDS counseling, outcome follow-up, or transportation assistance.
Table 3.8. The median number of clients in treatment at a facility on October 1, 2000 was 35. Government-owned facilities tended to have more clients per facility than did private facilities. Federal government-owned facilities overall had a higher median client count than other government-owned facilities, due primarily to the median number of clients in treatment at VA facilities (105).
The median number of clients also varied according to primary focus of the facility. Facilities with a focus on substance abuse treatment services or both substance abuse and mental health treatment had the largest number of clients, with a median of 40 and 34, respectively. Facilities with a primary focus on general health care had a median of 26 clients. Mental health focused facilities reported the lowest number of clients, with a median of 18.
Facilities were asked to report residential and hospital inpatient beds designated for substance abuse treatment.
Table 3.9. Some 3,044 facilities reported having 104,164 non-hospital residential beds designated for substance abuse treatment. More than 85 percent of these facilities were privately owned and accounted for 90 percent of the beds. On October 1, 2000, approximately 85 percent of all designated residential beds were in use by substance abuse treatment clients.
The utilization rate varied by ownership category from a low of 55 percent for Department of Defense-owned facilities to a high of 100 percent for State government-owned facilities. The majority of remaining ownership categories had utilization rates between 80 percent and 85 percent.
Utilization rates varied slightly depending on the primary focus of the facility. Facilities with a general health care focus had a utilization rate of 68 percent. Utilization rates for the remaining primary focus categories ranged from 79 percent to 89 percent.
Table 3.10. There were 13,230 hospital inpatient beds designated for substance abuse treatment among 614 reporting facilities. Nearly 80 percent of these facilities were privately owned and accounted for approximately 77 percent of the beds. On Ocotber 1, 2000, 69 percent of the designated hospital inpatient beds were in use by substance abuse treatment clients.
Utilization rates varied by ownership category with the lowest rate of 62 percent among private for-profit facilities. The Indian Health Service facilities reported clients in excess of designated capacity. Rates for the remaining ownership categories ranged from 67 percent to 93 percent.
Utilization rates among primary focus groups were less varied. Facilities with a substance abuse focus had a rate of 68 percent, while facilities with a substance abuse and mental health focus had a rate of 69 percent. Mental health and general health focused facilities had similar utilization rates (73 percent and 75 percent, respectively).
Figure 6 shows the distribution of the facility-level utilization
rates separately for residential and hospital inpatient beds. Approximately 68 percent of
the facilities with residential beds were at or near capacity on the reference date. In
contrast, 44 percent of the facilities with hospital inpatient beds had utilization rates
in that range.
